William Wilberforce

William Wilberforce is a care home which provides accommodation and personal care for those who may have dementia or a physical disability. The service can support 64 people in one adapted building. At the time of the inspection 62 people were using the service.

People’s experience of using this service and what we found

People who required staff to administer their medicines did not always receive the right support. We could not be assured that staff followed the prescribers’ instructions when administering time specific medicines to people. People were not always offered the opportunity to express to staff if they required pain relief.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The provider’s quality assurances systems had not identified the concerns we found during the inspection. The audits in place were not robust and lacked detail to evidence what had been reviewed as part of the audit. Records to support the safe management of medicines and records to show the service followed the principles of the Mental Capacity Act (MCA) were not always completed.

People were happy living at the service. Staff engaged with people in a meaningful way and respected their diversity. Risks to people were assessed and reviewed on a regular basis. Staff were recruited safely and understood the principles of keeping people safe.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection.

The last rating for this service was good (published 25 October 2019).

Why we inspected

We received concerns in relation to staffing levels and seeking medical attention in a timely manner. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for William Wilberforce on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe management of medicines and management oversight at this inspection.

We have made a recommendation in relation to the provider following the principles of MCA and regarding analysis of themes and trends related to accidents and incidents.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of spread of infection. This included comprehensive checks for visitors on arrival.

The service was extremely clean, tidy, and well maintained. The service had prominent and clear infection prevention control (IPC) signs with helpful information and best practice guidance. Staff were adhering to Personal Protective Equipment (PPE) guidelines and extra PPE locations had been appropriately placed around the service.

The registered manager had a good understanding about the impact of the pandemic on the people they supported. They recognised the particular difficulties people faced and staff did all they could to make reasonable and safe adjustments to support people and meet their needs. For example, providing isolation boxes. These contained various items to keep people stimulated whilst in isolation.

William Wilberforce is a residential care home providing personal care for up to 64 older people and younger adults, some of whom may be living with dementia or a physical disability.

People’s experience of using this service and what we found

People living at William Wilberforce told us they were happy and well cared for. Staff were aware of the importance of keeping people safe and demonstrated a clear understanding of people’s diverse needs and how to support their independence.

Staff followed best practice guidance to ensure medicines were managed and administered safely. People received support to take their medicines as prescribed.

A range of checks were carried out on staff prior to commencing their duties to ensure they were suitable to work in the service. All staff completed an induction to their role and were provided with ongoing training, supervision and appraisal to ensure they had the right skills and knowledge to support people safely in line with best practice guidance.

Staff understood their roles and knew what was expected of them. People were treated respectfully; their dignity was promoted. People had good access to other health professionals to maintain their wellbeing.

Care and support was tailored to each person's needs and preferences. Where people were able to, they were fully involved in their care plans. Where assessments confirmed people did not always have capacity to make decisions, staff understood the importance of offering choice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had built positive, supportive relationships with people which enabled friendly conversations and offers of reassurance when required. The home employed a dedicated staff member to provide people with the opportunity to engage in a variety of activities, events and interests of their choosing.

The management team were passionate about the service and responsive to any concerns. Staff spoke positively about the way they were managed and the support they received. Everybody told us the management team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (Published 13 March 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

William Wilberforce is a ‘care home’ without nursing for up to 64 older people, some of whom were living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection in October and November 2018 we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care, good governance, dignity and respect, need for consent, safe care and treatment, safeguarding, nutrition and hydration, staffing and duty of candour. In addition, we identified the provider was continuing to be in breach of their (Registration) Regulations 2009. This was because they had not submitted notifications of safeguarding incidents to the CQC, which they are required to do by law. As a result of our findings, we rated the service overall ‘Inadequate’ and the service was placed in ‘special measures’. We asked the provider to take action to make improvements.

At this inspection significant improvements had been made in most of the key areas of highest risk. The provider was no longer in breach of seven of the regulations. However, there remained a breach in relation to good governance and person-centred care. This was because the provider required more time to ensure work to improve care plans and the consistency of documentation was completed and sustained. This would ensure staff had sufficient information to provide person-centred care.

There was a registered manager at the service, who was also the nominated individual for the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The nominated individual is a person nominated by the provider to represent them and is responsible for supervising the management of the regulated activity provided.

The registered manager demonstrated better oversight of the service at this inspection. They were supported by a deputy manager who knew people’s needs well. There was a quality assurance system in place and audits were conducted. We found examples where audits had led to improvements being made, but they had still not been fully effective in identifying and addressing all issues. Due to the short period of time since our last inspection the provider had not completed work to improve the care records for all people. Progress had been made on this though, and overall care plans had improved and were more consistently updated. There was additional information for staff about risks and health conditions, but some files still contained inconsistencies or needed clearer guidance for staff about how to support people. For example, when the person may present distressed behaviours.

Staff demonstrated a better understanding of people’s needs and risks in relation to their health and well-being. This had led to improvements in the care provided. Monitoring documentation generally showed staff were providing care in line with people’s needs. This included increased observation checks and regular repositioning. Referrals had been made to health professionals when required.

The provider had taken appropriate action in response to accidents and incidents to try and prevent recurrences. They had a better knowledge of safeguarding processes and had made referrals to the safeguarding team when required.

Staff had received additional training since our last inspection. Work was on-going to assess staff competency following training and to plan additional training where required.

People were supported to have choice and control of their lives and Deprivation of Liberty Safeguards applications had been made where required. Further improvement was needed to evidence best interests decisions that had been made on behalf of people who lacked capacity to consent to particular decisions.

There had been improvements to medicines practices. There remained some minor issues to address, but overall medicines were safely managed.

People and relatives told us staff were kind and we observed positive, caring interactions between people and staff. Staff understood how to uphold people’s privacy and dignity.

The support and monitoring of people at risk of dehydration and malnutrition had improved. Staff were aware of people’s dietary needs and offered a choice of meals.

Servicing and maintenance of the environment had been carried out in a timely manner and infection prevention and control measures were robust and well managed.

The overall rating for this service is ‘Requires Improvement’ and the service is therefore no longer in ‘special measures’. You can see what action we told the provider to take at the back of the full version of the report.

William Wilberforce is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care and good governance. In addition, we identified that the provider was in breach of their (Registration) Regulations 2009. This was because the provider had not submitted notifications of safeguarding incidents to the Care Quality Commission, which they are required to do by law. As a result of our findings, we rated the service overall ‘Requires Improvement.’

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, responsive and well-Led to at least good. The provider’s action plan advised that the improvements they intended to make would be in place by 17 December 2018. As this inspection was brought forward, the provider was unable to demonstrate sustainable improvements in these areas. We have taken this into consideration when making our judgements and ratings for this report.

At this inspection we found continued breaches of Regulation 9 Person centred care and Regulation 17 Good Governance. In addition, we found breaches of Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 14 Meeting hydration and nutritional needs, Regulation 18 Staffing and Regulation 20 Duty of candour. The provider had continued to be in breach of their (Registration) Regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were two registered managers employed by the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We were told following the inspection that one registered manager had left the service. At the time of our inspection they had been registered at the service since 21 August 2017. This meant that since our inspection one registered manager was in place who has been registered with the commission since 9 October 2013. This person is also the nominated individual. The nominated individual is an appropriate person nominated by the provider to represent them. The nominated individual is responsible for supervising the management of the regulated activity provided.

The nominated individual advised us they had delegated specific roles to the registered manager that was previously in post. This was because of our previous inspection findings and in order to meet the breaches of regulation. This included auditing care plans to reflect a person-centred approach and submitting retrospective safeguarding notifications to CQC. Since our last inspection the provider had employed additional staff to support with audits and had taken measures to delegate specific roles to other senior staff. These included areas such as; infection prevention and control, falls audits and analysis and Deprivation of Liberty Safeguards (DoLS) applications.

During this inspection we found multiple failings at the service and risks to people had not been mitigated. Some people were not cared for appropriately.

Where risks to people had been identified and monitoring was in place, the written monitoring records did not always reflect the practice of staff. Some risks associated to people’s health conditions had no risk assessments in place to guide staff in supporting them. Measures had not always been put in place to adequately manage risks to people.

Accidents and incidents were not analysed thoroughly and measures were not put in place to mitigate repeat incidents. Staff did not always follow the provider’s procedures for people that were at risk of dehydration and malnutrition and appropriate monitoring and/or guidance was not always in place to support referrals to health professionals. In addition, positional changes for people were not carried out according to the instructions in people’s care plans putting them at risk of skin damage.

The majority of staff were recruited safely but there were insufficient numbers of staff to meet people’s needs effectively. Some people had behaviours that challenged staff and staff were not trained in this area. The provider had identified gaps in staff’s knowledge and training was being booked to support further development in this area.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. The principles of the Mental Capacity Act (MCA) 2005 were not fully understood by staff and the correct process for making best interest decisions had not been followed.

Medicines were not managed well in every area of the service and we found multiple issues that had not been identified by the provider’s checks.

Staff were described by people as being caring and we saw kindness shown to people by some staff. However, other staff did not always promote people's dignity or meet people's basic care needs in a timely way.

Care plans did not always reflect the care we observed being provided by staff and were generic and task focused. This did not encourage person-centred care practices. When people’s needs had changed care plans had not been updated.

Activities were not meaningful to people living with dementia. There were no stimulating activities for people during the inspection and very few items available to encourage ad-hoc activities for those people walking up and down communal areas. The service had some characteristics of a dementia friendly environment but did not always reflect current good practice guidance.

People and their relatives knew how to make a complaint but on one occasion a relative had raised concerns to staff over several months which were not escalated to senior management to address. These issues were highlighted and addressed as part of this inspection.

There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service. This was now being addressed by the registered provider but there were still significant areas of concern. The quality assurance system was not effective. The issues found at the inspection had not always been identified through auditing and monitoring. For example; some medicines audits had not identified errors in warfarin administrations and a lack of effective monitoring of pain relief medicines. Several medicines audits were signed as completed when it was clear actions were still in progress.

Records were at times not reflective of the care people received and updated hours after staff had completed their duties.

Internal investigations into accidents and incidents had not been thoroughly completed and raised concerns in relation to the service being open and transparent. The provider has advised one of these is awaiting further investigation and they will inform us of the outcomes.

The provider had not submitted all safeguarding notifications to the local authority or CQC. This was a continued issue since the last inspection.

Improvements had been made in relation to the dining experience and the chef was aware of how to fortify diets and provided fortified drinks and finger foods for people. However, support when monitoring those people at risk of dehydration and malnutrition was poor. The systems in place did not support best practice and left people vulnerable to harm and neglect.

Servicing and maintenance of the environment had been carried out in a timely manner and infection prevention and control measures were organised, thorough and effective.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For

William Wilberforce is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

William Wilberforce provides accommodation and support to a maximum of 64 people some of whom may be younger or older adults that may have physical disabilities and/or living with dementia. At the time of our inspection there were 55 people using the service. The home is purpose built with all rooms being en-suite over three floors. Rooms on the ground floor have access to a small patio. People living with dementia live in various areas within the home. However, on the ground floor some people are living with dementia that may require higher levels of support and supervision from staff. A large safe garden is available for residents to access freely and parking is available on site. The home is located on the outskirts of Pocklington in East Yorkshire.

There was a registered manager in post at the time of this inspection. However, they were unable to be present during this inspection. We were supported by the deputy manager and director in their absence. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments associated with people's care and support had been completed.

People did not always receive consistent person centred care and support to meet their individual needs, and preferences.

People received their medicines as prescribed and these were stored safely. However, medicines for pain relief were not always monitored to check their effectiveness.

Staffing levels were seen to be sufficient to meet people’s needs.

A variety of quality assurance systems were in place and identified areas that required improvements to be made. Records showed actions plans had been implemented to ensure improvements were made throughout the service. However, the systems in place did not identify some of the issues we raised during this inspection.

We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service which the provider is legally required to inform us of. We will deal with the notification issue outside of this inspection process.

Systems were in place to protect people from avoidable harm and abuse. Staff had good knowledge of the types of abuse and how to report them.

Recruitment included pre-employment checks to ensure people were of a suitable character to work in a care home environment.

Robust systems and processes ensured the safe management of infection prevention and control.

Staff adhered to the Mental Capacity Act and asked for people’s consent before carrying out care and support tasks. For people who lacked capacity to make decisions for themselves best interest decisions were arranged with health professionals and relatives input.

Staff received refresher training relevant to their role and senior managers provided additional support during observational practice. Health professionals had delivered some specialised training in dementia to support staff in managing behaviours positively. Supervisions were regularly completed and encouraged reflective practices.

Staff encouraged people to be as independent as they could be and knew people’s levels of independence to be able to support them appropriately.

People told us they felt staff were caring, helpful and kind to them. They felt staff respected their wishes and that their privacy and dignity was maintained.

Policies were in place to support staff in promoting equality and recognising people's diverse needs.

Regular activities were arranged within the service including barbecues, entertainment and films shown at the in-house cinema. Relatives were encouraged to attend all events and activities.

Systems were in place for people or their relatives to raise a complaint if they wished to do so. Information was readily available and included in the service user handbook.

The provider sought feedback from people and their relatives to improve the service. Records showed that changes had been made as a result of suggestions made by both relatives and people living at the service.

Further information is in the detailed findings below.

The home is registered to provide accommodation for up to 64 people, some of whom may be living with dementia. On the day of the inspection there were 52 people living at the home, meaning that the top floor of the premises was unoccupied.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed who would be replacing the current registered manager (who was also a director of the company) when they had been registered as the manager.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

People told us that they felt safe whilst they were living at William Wilberforce. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Staff also told us that they would not hesitate to use the home’s whistle blowing procedure if needed.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Staff had received training on the administration of medication and people told us they were happy with how they received their medicines.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff and that their care plans were reviewed and updated as needed. People’s nutritional needs had been assessed and people told us they were very happy with the food provided.

People told us they would not hesitate to express concerns or make a complaint, and they were confident their concerns would be listened to and acted on. There was a process in place to manage complaints that were received by the home. In addition to this, there were systems in place to seek feedback from people who lived at the home, relatives and staff.

Care staff, people who lived at the home and relatives told us that the home was well managed. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote safety and optimum care to people who lived at the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity and they were encouraged to be involved in how the service was run through inclusion in regular meetings and staff recruitment practices.

We found that people had their own detailed care file, which identified their individual needs and abilities, choices, decisions and likes and dislikes. In addition to this information there were risk assessments to cover daily activities of life. The risk assessments ensured people were kept as safe as possible, whilst accommodating their decisions and choices around their day to day care.

There were clear policies and procedures in place and safe and effective medicine practices being followed within the service. People were supported and reminded to self-administer their medicines independently where they wished to do so, following a risk assessment of their capabilities.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary and mobility needs had been identified in care plans where required. People said their care plans were up to date and reflected their current needs.

People who had capacity told us they were aware that they could be supported by an advocate if needed. A number of people had power of attorney arrangements with solicitors or their families with regard to health and welfare and finances. These arrangements were clearly documented in their care files.

Staff had received appropriate professional development and training to ensure they could meet the needs of the people who used the service. Staff were aware of what care each person required to meet their needs. Staff were able to say which people had input from the district nurse or dietician, they also knew what health problems each person had and what action was needed from them to support the person.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff acted in a friendly and supportive manner, whilst being professional and courteous when speaking to people and visitors to the service.

People said they thought their health had improved since coming into the home. One person said 'I have seen my GP regularly and they have reduced my medication as I am so much better. I put this down to the marvellous care and attention that I get from the staff here. They are lovely lasses; they spend time with you and make sure you are okay.'

Nutritional screening was completed by the staff and people were weighed weekly or monthly depending on their level of risk. We saw that the service used a dietician when this was required. Skin integrity was monitored and assistance from the district nurse was used when required.

Is the service responsive?

People who spoke with us were confident of speaking to the manager or staff if they had any issues and one person told us 'I have spoken to the manager about my personal care. I was listened to and staff acted promptly to accommodate my wishes and choices.'

Regular meetings were held with people who used the service and these were an opportunity for individuals to express their views on the care provided, menus, staff members, activities within the service and prospective outings. People told us that initially these were weekly which they found to be too onerous, and now they were held monthly. Changes to the service had been made in response to people's feedback and these included updated menus, more activities and an improved laundry service.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service had continually improved.

People were very satisfied with the service. They told us 'The food is very good', 'Staff attitude towards us is superb', 'Staff are wonderful' and 'I would not change a thing'.